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Luca M, Ciobanu A. Polyp detection in video colonoscopy using deep learning. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-219276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Video colonoscopy automatic processing is a challenge and further development of computer assisted diagnosis is very helpful in correctness assessment of the exam, in e-learning and training, for statistics on polyps’ malignity or in polyps’ survey. New devices and programming languages are emerging and deep learning begun already to furnish astonishing results, in the quest for high speed and optimal polyp detection software. This paper presents a successful attempt in detecting the intestinal polyps in real time video colonoscopy with deep learning, using Mobile Net.
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Affiliation(s)
- Mihaela Luca
- Institute of Computer Science, Romanian Academy Iaşi Branch, Iaşi, Romania
| | - Adrian Ciobanu
- Institute of Computer Science, Romanian Academy Iaşi Branch, Iaşi, Romania
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2
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Post-polypectomy colonoscopy surveillance: Can we improve the diagnostic yield? GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:474-487. [PMID: 34848307 DOI: 10.1016/j.gastrohep.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022]
Abstract
Although adenomas and serrated polyps are the preneoplastic lesions of colorectal cancer, only few of them will eventually progress to cancer. This review provides a comprehensive overview of the present and future of post-polypectomy colonoscopy surveillance. Post-polypectomy surveillance guidelines have recently been updated and all share the aim towards more selective and less frequent surveillance. We have examined these current guidelines and compared the recommendations of each of them. To improve the diagnostic yield of post-polypectomy surveillance it is important to find predictors of metachronous polyps that better identify high-risk individuals of developing advanced neoplasia. For this reason, we have also conducted a literature review of the molecular biomarkers of metachronous advanced colorectal polyps. Finally, we have discussed future directions of post-polypectomy surveillance and identified possible strategies to improve the use of endoscopic resources with the COVID-19 pandemic.
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3
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Müskens JLJM, Kool RB, van Dulmen SA, Westert GP. Overuse of diagnostic testing in healthcare: a systematic review. BMJ Qual Saf 2021; 31:54-63. [PMID: 33972387 PMCID: PMC8685650 DOI: 10.1136/bmjqs-2020-012576] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Overuse of diagnostic testing substantially contributes to healthcare expenses and potentially exposes patients to unnecessary harm. Our objective was to systematically identify and examine studies that assessed the prevalence of diagnostic testing overuse across healthcare settings to estimate the overall prevalence of low-value diagnostic overtesting. METHODS PubMed, Web of Science and Embase were searched from inception until 18 February 2020 to identify articles published in the English language that examined the prevalence of diagnostic testing overuse using database data. Each of the assessments was categorised as using a patient-indication lens, a patient-population lens or a service lens. RESULTS 118 assessments of diagnostic testing overuse, extracted from 35 studies, were included in this study. Most included assessments used a patient-indication lens (n=67, 57%), followed by the service lens (n=27, 23%) and patient-population lens (n=24, 20%). Prevalence estimates of diagnostic testing overuse ranged from 0.09% to 97.5% (median prevalence of assessments using a patient-indication lens: 11.0%, patient-population lens: 2.0% and service lens: 30.7%). The majority of assessments (n=85) reported overuse of diagnostic testing to be below 25%. Overuse of diagnostic imaging tests was most often assessed (n=96). Among the 33 assessments reporting high levels of overuse (≥25%), preoperative testing (n=7) and imaging for uncomplicated low back pain (n=6) were most frequently examined. For assessments of similar diagnostic tests, major variation in the prevalence of overuse was observed. Differences in the definitions of low-value tests used, their operationalisation and assessment methods likely contributed to this observed variation. CONCLUSION Our findings suggest that substantial overuse of diagnostic testing is present with wide variation in overuse. Preoperative testing and imaging for non-specific low back pain are the most frequently identified low-value diagnostic tests. Uniform definitions and assessments are required in order to obtain a more comprehensive understanding of the magnitude of diagnostic testing overuse.
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Affiliation(s)
- Joris L J M Müskens
- IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Rudolf Bertijn Kool
- IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Simone A van Dulmen
- IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Gert P Westert
- IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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4
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Venturelli F, Ottone M, Pignatti F, Bellocchio E, Pinotti M, Besutti G, Djuric O, Giorgi Rossi P. Using text analysis software to identify determinants of inappropriate clinical question reporting and diagnostic procedure referrals in Reggio Emilia, Italy. BMC Health Serv Res 2021; 21:103. [PMID: 33514372 PMCID: PMC7847028 DOI: 10.1186/s12913-021-06093-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate prescribing of diagnostic procedures leads to overdiagnosis, overtreatment and resource waste in healthcare systems. Effective strategies to measure and to overcome inappropriateness are essential to increasing the value and sustainability of care. We aimed to describe the determinants of inappropriate reporting of the clinical question and of inappropriate imaging and endoscopy referrals through an analysis of general practitioners' (GP) referral forms in the province of Reggio Emilia, Italy. METHODS A clinical audit was conducted on routinely collected referral forms of all GPs of Reggio Emilia province. All prescriptions for gastroscopy, colonoscopy, neurological and musculoskeletal computerised tomography (CT) and magnetic resonance imaging (MRI) from 2012 to 2017 were included. The appropriateness of referral forms was assessed using Clinika VAP software, which combines semantic analysis of clinical questions and available metadata. Local protocols agreed on by all physicians defined criteria of appropriateness. Two multilevel logistic models were used to identify multiple predictors of inappropriateness of referral forms and to analyse variability among GPs, primary care subdistricts and healthcare districts. RESULTS Overall, 37% of referral forms were classified as inappropriate, gastroscopy and CT showed higher proportions of inappropriate referrals compared to colonoscopy and MRI. Inappropriateness increased with patient age for CT and MRI; for gastroscopy, it was lower for patients aged 65-84 compared to those younger, and for colonoscopy, it was higher for older patients. Fee exemptions were associated with inappropriateness in MRI referral forms. The effect of GPs' practice organization was consistent across all tests, showing higher inappropriateness for primary care medical networks than in primary care medical groups. Male GPs were associated with inappropriateness in endoscopy, and older GPs were associated with inappropriateness in musculoskeletal CT. While there was moderate variability in the inappropriate prescribing among GPs, there was not among the healthcare districts or primary care subdistricts. CONCLUSIONS Routinely collected data and IT tools can be useful to identify and monitor diagnostic procedures at high risk of inappropriate prescribing. Assessing determinants of inappropriate referral makes it possible to tailor educational and organizational interventions to those who need them.
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Affiliation(s)
- Francesco Venturelli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marta Ottone
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy.
| | - Fabio Pignatti
- Department of Primary Care, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eletta Bellocchio
- Department of Primary Care, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mirco Pinotti
- Department of Primary Care, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Besutti
- Clinical and Experimental Medicine PhD program, University of Modena and Reggio Emilia, Modena, Italy.,Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Olivera Djuric
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
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5
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Vanella G, Capurso G, Boškoski I, Bossi E, Signorelli C, Ciceri F, Arcidiacono PG, Costamagna G. How to get away with COVID-19: endoscopy during post-peak pandemic. A perspective review. Therap Adv Gastroenterol 2020; 13:1756284820965070. [PMID: 33093872 PMCID: PMC7548539 DOI: 10.1177/1756284820965070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/25/2020] [Indexed: 02/04/2023] Open
Abstract
The SARS-CoV-2 pandemic has changed the way we work, and health care services have to adapt. The use of personal protective equipment (PPE) and the delay of non-urgent procedures were the immediate measures adopted by Gastrointestinal (GI) Endoscopy Units at the time of crisis. As the peak has now passed in most countries, GI facilities are facing the next challenge of this pandemic: service providers must adapt their routine work to a 'new normal'. Routine casework must resume, and waiting lists must be addressed: all in the awareness of the ongoing potential risks of COVID-19, and the threat of a second wave. In this review, we discuss strategies to manage the workload by improving procedure appropriateness and prioritization, whilst maintaining a 'COVID-free' environment. This includes monitoring of an adequate stock of PPE and the implications for the staff's workload, and the GI trainees' need of training.
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Affiliation(s)
- Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography
Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele
University, Milan, Italy
| | - Gabriele Capurso
- Pancreatobiliary Endoscopy and Endosonography
Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele
University, Milan, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico
Universitario Agostino Gemelli IRCCS, Rome, Italy,Centre for Endoscopic Research Therapeutics and
Training (CERTT), Università Cattolica del Sacro Cuore di Roma, Italy
| | - Eleonora Bossi
- School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
| | - Fabio Ciceri
- Department of Haematology and Stem Cell
Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San
Raffaele University, Milan, Italy
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6
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Shine R, Bui A, Burgess A. Quality indicators in colonoscopy: an evolving paradigm. ANZ J Surg 2020; 90:215-221. [PMID: 32086869 DOI: 10.1111/ans.15775] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/14/2019] [Accepted: 01/20/2020] [Indexed: 12/27/2022]
Abstract
The year 1969 marked a revolution in the diagnosis of colorectal cancer (CRC). It is when Dr Wolff developed the colonoscope and quickly realized its potential in both diagnosis and treatment of colonic neoplasms. Over the past 50 years there has been exponential increase in utilization of colonoscopy with over 1 million colonoscopies performed annually throughout Australasia. Endoscopic removal of pre-malignant lesions has been proven to reduce the incidence and mortality of colorectal. Although timing and frequency of surveillance colonoscopy plays a crucial role in risk reduction of CRC, this is dependent upon the findings of the index colonoscopy. The goal of screening colonoscopy is to detect CRC and identify and remove pre-malignant neoplasms that risk progression to CRC. With increasing uptake of bowel screening throughout Australasia, there is increasing pressure to ensure all endoscopists and endoscopy units perform at a universal high-quality. All too often high demand and constant delays compromise colonoscopy quality. Without clear and concise quality indicators with transparent measurement and audit, these flaws can quickly jeopardize screening goals and patient outcomes. This review aims to explore six key quality indicators and explore the evidence behind the current recommended standards. These key indicators include; rate of adequate bowel preparation, caecal intubation rate, adenoma detection rate, withdrawal time, complication rates and surveillance intervals.
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Affiliation(s)
- Rebecca Shine
- General Surgery, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Andrew Bui
- Colorectal Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Adele Burgess
- Colorectal Surgery, Austin Health, Melbourne, Victoria, Australia
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Beg S, Sansone S, Manguso F, Schembri J, Patel J, Thoufeeq M, Corbett G, Ragunath K. The Conversion of Planned Colonoscopy to Sigmoidoscopy and the Effect of this Practice on the Measurement of Quality Indicators. Am J Gastroenterol 2017; 112:1545-1552. [PMID: 28555631 DOI: 10.1038/ajg.2017.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 04/04/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES A cecal intubation rate (CIR) of >90% is a well-accepted quality indicator of colonoscopy and is consequently monitored within endoscopy units. Endoscopists' desire to meet this target may mean that incomplete colonoscopies are recorded as flexible sigmoidoscopies. The aim of this study was to examine whether the conversion of requested colonoscopies is a clinically significant phenomenon and whether this impacts upon the measurement of quality indicators. METHODS A retrospective review of all flexible sigmoidoscopies performed between 1 January 2015 and 31 December 2015 at Nottingham University Hospitals, Sheffield Teaching Hospitals, and Cambridge University Hospitals was performed. Where a colonoscopy was requested but a flexible sigmoidoscopy performed, the patient's records and endoscopy reports were reviewed to determine whether this conversion was decided before the start of the procedure and documented. RESULTS During the 12-month period, 6,839 flexible sigmoidoscopies were performed by 125 endoscopists. The original requests of 149 sigmoidoscopies could not be retrieved and were therefore excluded from this analysis. Of the 6,690 sigmoidoscopy requests reviewed, 2.8% (n=190) procedures were originally requested as a colonoscopy. On review of patient records, 85 conversions were appropriate according to pre-defined criteria. However, 105 conversions were deemed inappropriate, occurring in patients who had a valid documented indication for colonoscopy and had undergone full bowel preparation. The most common reasons cited included poor bowel preparation (n=37), technically challenging procedure (n=24), at the endoscopist's discretion based on clinical factors (n=21), and obstructing patology (n=8). A clear reason for conversion was not apparent in 11 cases. During the study period, 21,271 colonoscopies were performed and so conversions represent 0.45% of the total requests. When inappropriate conversions were included in individuals' performance data, 15 endoscopists fell to ≤90% target cecal intubation target. CONCLUSIONS A small, but significant number of colonoscopies are converted to flexible sigmoidoscopies at the time of the procedure. This study demonstrates the conversion of colonoscopy to sigmoidoscopy as being a potential limitation of relying on CIR alone. Endoscopy units should consider monitoring the rate of inappropriate conversions to ensure quality.
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Affiliation(s)
- Sabina Beg
- Queens Medical Centre, Nottingham University Hospitals, Gastroenterology, Nottingham, UK
| | - Stefano Sansone
- Queens Medical Centre, Nottingham University Hospitals, Gastroenterology, Nottingham, UK
| | - Francesco Manguso
- Queens Medical Centre, Nottingham University Hospitals, Gastroenterology, Nottingham, UK
| | - John Schembri
- Queens Medical Centre, Nottingham University Hospitals, Gastroenterology, Nottingham, UK
| | - Jay Patel
- Queens Medical Centre, Nottingham University Hospitals, Gastroenterology, Nottingham, UK
| | - Mo Thoufeeq
- Queens Medical Centre, Nottingham University Hospitals, Gastroenterology, Nottingham, UK
| | - Gareth Corbett
- Queens Medical Centre, Nottingham University Hospitals, Gastroenterology, Nottingham, UK
| | - Krish Ragunath
- Queens Medical Centre, Nottingham University Hospitals, Gastroenterology, Nottingham, UK
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8
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Sneh Arbib O, Zemser V, Leibovici Weissman Y, Gingold-Belfer R, Vilkin A, Eizenstein S, Cohen A, Comaneshter D, Tzipora S, Niv Y, Ringel Y, Lieberman D, Levi Z. Risk of advanced lesions at the first follow-up colonoscopy after polypectomy of diminutive versus small adenomatous polyps of low-grade dysplasia. Gastrointest Endosc 2017; 86:713-721.e2. [PMID: 28284884 DOI: 10.1016/j.gie.2017.02.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/23/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The current guidelines for surveillance after polypectomy do not distinguish between diminutive (1-5 mm) and small (6-9 mm) polyps with low-grade dysplasia (LGD). We aimed to evaluate the risk for advanced neoplasia on follow-up colonoscopy. METHODS We retrospectively analyzed 443 patients whose worst finding at index colonoscopy was polypectomy of 1 to 5 or 6 to 9 mm polyps with LGD and those who underwent a follow-up colonoscopy. RESULTS During a mean follow-up of 32.0 months (interquartile range 13-48 months), advanced neoplasia was found in 26 patients (5.9%). Among all included patients (n = 443), advanced neoplasia was found in 13 of 310 patients (4.2%) of the 1- to 5-mm group versus 13 of 133 patients (9.8%) of the 6- to 9-mm group (hazard ratio [HR], 3.49; 95% confidence interval [CI], 1.6-7.6). Among the patients with 1 to 2 polyps resected (n = 313), advanced neoplasia was found in 8 of 231 patients (3.5%) of the 1- to 5-mm group versus 8 of 82 patients (9.8%) of the 6- to 9-mm group (HR 3.97; 95% CI, 1.47-10.7). Among the patients with ≥3 polyps resected (n = 130), advanced neoplasia was found in 5 of 79 patients (6.3%) of the 1- to 5-mm group versus 5 of 51 patients (9.8%) of the 6- to 9-mm group (HR 2.4; 95% CI, 0.7-8.36). Fair bowel preparation also was associated with the risk for advanced neoplasia at follow-up (HR 3.87, 95% CI, 1.70-8.82). CONCLUSIONS Our findings suggest that among patients with up to 9-mm adenomatous polyps, a polyp size of 6 to 9 mm, >2 polyps, and fair bowel preparation are associated with advanced neoplasia.
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Affiliation(s)
- Orly Sneh Arbib
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Valentina Zemser
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Yaara Leibovici Weissman
- Department of Internal Medicine D, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Alex Vilkin
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Sapir Eizenstein
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Arnon Cohen
- Department of Quality Measures and Research, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Doron Comaneshter
- Department of Quality Measures and Research, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
| | - Shochat Tzipora
- Statistics Service, Rabin Medical Center, Petah Tikva, Israel
| | - Yaron Niv
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Yeuda Ringel
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Zohar Levi
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Zorzi M, Senore C, Turrin A, Mantellini P, Visioli CB, Naldoni C, Sassoli De' Bianchi P, Fedato C, Anghinoni E, Zappa M, Hassan C. Appropriateness of endoscopic surveillance recommendations in organised colorectal cancer screening programmes based on the faecal immunochemical test. Gut 2016; 65:1822-1828. [PMID: 26297727 DOI: 10.1136/gutjnl-2015-310139] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/10/2015] [Accepted: 08/05/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To assess the appropriateness of recommendations for endoscopic surveillance in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT). DESIGN 74 Italian CRC screening programmes provided aggregated data on the recommendations given after FIT-positive colonoscopies in 2011 and 2013. Index colonoscopies were divided into negative/no adenoma and low- risk, intermediate-risk and high-risk adenomas. Postcolonoscopy recommendations included a return to screening (FIT after 2 years or 5 years), an endoscopic surveillance after 6 months or after 1 year, 3 years or 5 years, surgery or other. We assessed the deviation from the postcolonoscopy recommendations of the European Guidelines in 2011 and 2013 and the correlation between overuse of endoscopic surveillance in 2011 and the process indicators associated with the endoscopic workload in 2013. RESULTS 49 704 postcolonoscopy recommendations were analysed. High-risk, intermediate-risk and low-risk adenomas, and no adenomas were reported in 5.9%, 19.3%, 15.3% and 51.5% of the cases, respectively. Endoscopic surveillance was inappropriately recommended in 67.4% and 7%, respectively, of cases with low-risk and no adenoma. Overall, 37% of all endoscopic surveillance recommendations were inappropriate (6696/17 860). Overuse of endoscopic surveillance was positively correlated with the extension of invitations (correlation coefficient (cc) 0.29; p value 0.03) and with compliance with post-FIT+ colonoscopy (cc 0.25; p value 0.05), while it was negatively correlated with total colonoscopy waiting times longer than 60 days (cc -0.26; p value 0.05). CONCLUSIONS In organised screening programmes, a high rate of inappropriate recommendations for patients with low risk or no adenomas occurs, affecting the demand for endoscopic surveillance by a third.
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Affiliation(s)
- Manuel Zorzi
- Registro Tumori del Veneto, Regione Veneto, Padova, Italy
| | - Carlo Senore
- AOU Città della Salute e della Scienza, CPO Piemonte, Torino, Italy
| | - Anna Turrin
- Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venezia, Italy
| | - Paola Mantellini
- Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| | | | - Carlo Naldoni
- Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy
| | | | - Chiara Fedato
- Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venezia, Italy
| | - Emanuela Anghinoni
- Servizio Medicina Preventiva nelle Comunità-AUSL Mantova, Mantova, Italy
| | - Marco Zappa
- Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| | - Cesare Hassan
- Unità di Gastroenterologia, Ospedale Nuovo Regina Margherita, Roma, Italy
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Thompson C, Ismail T, Radley S, Walt R, Ward ST. Conversion of colonoscopy to flexible sigmoidoscopy: an unintended consequence of quality measurement in endoscopy. Frontline Gastroenterol 2016; 7:202-206. [PMID: 27429734 PMCID: PMC4941159 DOI: 10.1136/flgastro-2015-100626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 11/01/2015] [Accepted: 11/10/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To quantify the proportion of requests for colonoscopy that are performed as flexible sigmoidoscopy and documented reasons for this in ordinary UK hospital practice. To determine the effect these requests have on colonoscopy completion rate if they are included in the denominator of the calculated rate by individual endoscopist. DESIGN Retrospective study of 22 months flexible sigmoidoscopy practice at a major UK teaching hospital. All flexible sigmoidoscopies performed had their associated request form examined. SETTING UK NHS University Hospital. PATIENTS All patients receiving outpatient flexible sigmoidoscopy from January 2013 to October 2014 with no exclusions. INTERVENTION Conversion of colonoscopy to flexible sigmoidoscopy. MAIN OUTCOME MEASURES Conversion of colonoscopy to flexible sigmoidoscopy, reason for conversion and adjusted colonoscopy completion rate. RESULTS 71 of the 3526 flexible sigmoidoscopies performed (2.0%), representing 71 of 5905 colonoscopy requests (1.2%). Conversion reason was noted only in 26 (37%) of converted cases. Adjustment of colonoscopy completion rate to include conversions pushed four of our unit's 22 endoscopists below the UK national 90% standard. CONCLUSIONS Conversion to flexible sigmoidoscopy occurs in 1.2% of patients originally booked for colonoscopy. The reason for this conversion is often unqualified and may be inappropriate. Conversion can affect the colonoscopy completion rate, and therefore, should be included in endoscopists' overall performance statistics.
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Affiliation(s)
- Chris Thompson
- Department of Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tariq Ismail
- Department of Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Radley
- Department of Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robert Walt
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stephen Thomas Ward
- Department of Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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11
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Bonnington SN, Rutter MD. Surveillance of colonic polyps: Are we getting it right? World J Gastroenterol 2016; 22:1925-1934. [PMID: 26877600 PMCID: PMC4726668 DOI: 10.3748/wjg.v22.i6.1925] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/15/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. The identification of colonic polyps can reduce CRC mortality through earlier diagnosis of cancers and the removal of polyps: the precursor lesion of CRC. Following the finding and removal of colonic polyps at an initial colonoscopy, some patients are at an increased risk of developing CRC in the future. This is the rationale for post-polypectomy surveillance colonoscopy. However, not all individuals found to have colonic adenomas have a risk of CRC higher than that of the general population. This review examines the literature on post-polypectomy surveillance including current international clinical guidelines. The potential benefits of surveillance procedures must be weighed against the burden of colonoscopy: resource use, the potential for patient discomfort, and the risk of complications. Therefore surveillance colonoscopy is best utilised in a selected group of individuals at a high risk of developing cancer. Further study is needed into the specific factors conferring higher risk as well as the efficacy of surveillance in mitigating this risk. Such evidence will better inform clinicians and patients of the relative benefits of colonoscopic surveillance for the individual. In addition, the decision to continue with surveillance must be informed by the changing profile of risks and benefits of further procedures with the patient’s advancing age.
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12
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Milana M, Santopaolo F, Lenci I, Francioso S, Baiocchi L. Results of a fast-track referral system for urgent outpatient hepatology visits. Int J Qual Health Care 2015; 27:132-6. [PMID: 25724880 DOI: 10.1093/intqhc/mzv011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE In 2011, our regional district adopted an experimental system for fast referral (within 72 h) by general practitioners to several outpatient specialist evaluations including hepatology. The aim of this study was to assess the characteristics and appropriateness of urgent hepatology visits. DESIGN Retrospective study. SETTING Hospital-based study in Italy. PARTICIPANTS A total of 192 subjects referred to our outpatient hepatology clinic classified as 'urgent' were compared with 397 patients evaluated with standard referral. A comparison with 200 patients visited just before the adoption of the new system was also included. MAIN OUTCOME MEASURES Patients' features and appropriateness of referral in urgent and non-urgent groups using the new system. RESULTS Increase in liver enzymes was the main factor that leads to specialist hepatology consultation and was more frequent in the urgent group (37% vs. 27.1%, P < 0.001). Liver malignancies were identified in 2.6% of patients in the urgent group, whereas this percentage was 10 times lower in the non-urgent group (P = 0.01). Urgent patients required inpatient admission more frequently compared with non-urgent patients (4.2% vs. 0.5%; P = 0.003). Inappropriate referral was recorded in 41% of cases in the urgent group (no reason for urgency 27%; condition not attributable to liver 13.5%). In the non-urgent group, consultations were inappropriate in 20.1% of cases (condition not attributable to liver). In comparison with the old system, the new one allocated >85% of patients with serious illness to urgent group. CONCLUSIONS This strategy is helpful in selecting patients with more serious hepatic conditions. Appropriateness of referral represents a crucial issue.
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Affiliation(s)
- Martina Milana
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
| | - Francesco Santopaolo
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
| | - Simona Francioso
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
| | - Leonardo Baiocchi
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
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Affiliation(s)
- Charles R Boardman
- Portland VA Medical Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Amnon Sonnenberg
- Portland VA Medical Center, Oregon Health & Science University, Portland, Oregon, USA
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14
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Belle S. Who Needs Follow-Up after Endoscopic Resection of Colorectal Adenomas? VISZERALMEDIZIN 2014; 30:52-5. [PMID: 26286014 PMCID: PMC4513796 DOI: 10.1159/000357745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Surveillance colonoscopy after endoscopic resection of colorectal adenomas is a crucial step in the concept of colorectal cancer screening. After identifying the patients at risk with screening and resection of adenomas, there has to be a tailored surveillance. Surveillance colonoscopy should detect recurrent and metachronal adenomas at a stage where they can be removed endoscopically. In the following, the criteria for a risk-adapted surveillance interval are presented. Methods A literature review based on American, European, and German guidelines for surveillance after polypectomy and the German guideline for the diagnosis and treatment of ulcerative colitis, as well as a selective literature search into hereditary colorectal cancer were performed. Results State of the art surveillance after endoscopic resection of colorectal adenomas is based on a focused anamnesis and the index colonoscopy. On the basis of existing guidelines, a risk-adapted surveillance strategy can be implemented. Conclusions Adherence to surveillance guidelines is a basic part of colorectal cancer screening and should be the starting point for further research.
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Affiliation(s)
- Sebastian Belle
- II. Medizinische Klinik, Universitätsmedizin Mannheim, Germany
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15
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Puente D, Cantero FX, Llagostera M, Piñeiro P, Nieto R, Saladich R, Mascort J, Marzo M, Almeda J, Segarra M. A cross-sectional study of the appropriateness of colonoscopy requests in the Spanish region of Catalonia. BMJ Open 2012; 2:e002207. [PMID: 23204141 PMCID: PMC3533100 DOI: 10.1136/bmjopen-2012-002207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Colonoscopies are being requested with increasing frequency in the last few years, as they are used both as a diagnostic and therapeutic procedure in several gastrointestinal diseases. Our purpose is to describe the appropriateness of colonoscopy requests issued both from primary care centres and from hospitals, according to the EPAGE II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). METHODS AND ANALYSIS Cross-sectional study. Colonoscopy requests issued since January 2011 and received at the endoscopy units of all six reference hospitals serving the primary care centres of the South Metropolitan and Central Catalonia districts will be collected (total=1500 requests). Variables to be collected include gender, date of birth, origin of the request and reference hospital, priority of the procedure, type of clinician requesting the procedure, date and indication of request, abdominal examination performed, anal inspection examination performed, date of last colonoscopy if applicable, diagnosis and date of diagnosis. Using the available information and the EPAGE II website, colonoscopy requests will be assigned as an appropriateness score. The association between the variables collected and the EPAGE II scores will be assessed using a Student's t test and a χ(2) test. A multilevel logistic model will be generated on the factors associated with the appropriateness of the requests. ETHICS AND DISSEMINATION Colonoscopy is a costly procedure and not free from complications. In order to increase cost effectiveness, reduce waiting lists and optimise resources, it is necessary to use tools such as the EPAGE II guidelines, which establish criteria to assess the appropriateness of colonoscopies. The purpose of this study is to describe the current situation and to discuss whether current clinical practice is appropriate. The results of the study will be published in the next few years. In consideration of the ethical principles and methods of the research study, approval was granted for the project.
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Affiliation(s)
- Diana Puente
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | | | - Maria Llagostera
- Gerència Territorial Metropolitana Sud, Institut Català de la Salut, L'Hospitalet del Llobregat, Spain
| | - Pilar Piñeiro
- Servei d'Atenció Primària (SAP) Penedès-Garraf-Llobregat Nord, ABS Penedès Rural, Institut Català de la Salut, Alt Penedès, Spain
| | - Raquel Nieto
- Servei d'Atenció Primària (SAP) Penedès-Garraf-Llobregat Nord, ABS Penedès Rural, Institut Català de la Salut, Alt Penedès, Spain
| | - Rosa Saladich
- EAP Sant Boi de Llobregat-4 (Vinyets), Institut Català de la Salut, Sant Boi de Llobregat, Spain
| | - Juanjo Mascort
- EAP L'Hospitalet de Llobregat-8 (Florida Sud), Institut Català de la Salut, L'Hospitalet de Llobregat, Spain
- Campus Bellvitge, Universitat de Barcelona, L'Hospitalet del Llobregat, Spain
| | - Mercè Marzo
- Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà, Spain
| | - Jesús Almeda
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Manel Segarra
- EAP Hospitalet de Llobregat-1 (Centre), Institut Català de la Salut, L'Hospitalet de Llobregat, Spain
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